Healthcare Provider Details

I. General information

NPI: 1407899495
Provider Name (Legal Business Name): ALICIA D SCOGGINS FNCP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WEST BLUFF
WOODVILLE TX
75979-0900
US

IV. Provider business mailing address

900 WEST BLUFF
WOODVILLE TX
75979-0900
US

V. Phone/Fax

Practice location:
  • Phone: 409-331-0202
  • Fax: 409-331-0222
Mailing address:
  • Phone: 409-331-0202
  • Fax: 409-331-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number564484
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: